Permit CITY OF TIGARD MECHANICAL PERMIT
N
IN • ' COMMUNITY DEVELOPMENT Permit #: MEC2013 -00188
13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/09/2013
T [ �' r1 P. g Parcel: 25111 CC 14100
Jurisdiction: Tigard
Site address: 10205 SW HIGHLAND DR
Project: Soule Subdivision: SUMMERFIELD NO.4 Lot: 192
Project Description: Replace furnace
Contractor: CLACKAMAS HEATING & COOLING LLC Owner: SOULE, MYRNA
15115 SE PENNY LEE CT. 10205 SW HIGHLAND DR
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 658 -4808 PHONE: 503 -407 -6476
FAX: 888 - 500 -2912
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/09/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /09/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /09/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct que . UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By. "Li Permittee Signatur ■ t� //� Mr
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Apr 08 13 12:45a Clackamas Heating &Cooling 18885002912 p.1
Mechanical Permit Applicati c EWED
City of Tigard
11((LL�,, � Permit No,: f
14
13125 SW Hall Blvd., Tigard. OR 97223 Tian Review
y 8 - `S C AD 13't�) / 8
Phone: 503.718.2439 Fax: .503.598.1960 O remit:
Inspection Line: 503.639.4175 , Q 8 2013 Date Fun
)�I,;� •,: 1�K 17ateJiesrlyBy. lust � B See Page 2 Far
Internet www.trgard- or.gov ?ksifiedlMethod: Sapplemental falmitarlo>t
CITY OFTIGARD CO .L �• SCHEDULE -- USE CHEO(LIST
TYPE OS{
„,..,. IN�] DIVISION
Mechanical Permit lees* are based on the value of the work
New construction Addition /alteration/replacement X performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and =fit.
Demolition Other: Value: S
CATEGORY OF CONSI'RU CT LON • RESIDENTIAL EQUIPMENT/ SYSTEMS FEES'
For spec ; ofut /ormorin„ toe checklist.
1- and 2-family dwelling( Commercialindustrial Accessory building
Desaiptitra I Qty. I Ea. I Total
Multi- family Master builder Other: , H ea ti na k pp g:
JOB SITE INFORMATION AND LOCATION Air conditioning •
(reclaim sheet', snowing, placement) 46.75 j j _
Job site address /UL 05 . 5/;,1/ 1 f if f'1 /61.110C j r Furnace 100.000 BTU (daetsis ats) / 46.75 if 4r7
7(
City /StatelZIP: - `) a 9 f ' Furnace 100,0004- BTU (duets/vents) t 54.9] _
/ pump
Suite/bldg./apt. no.: l Project name: (requires sae plan sbowi rKplacement) 61.46
Duct work 23.32
Cross street/directions to job site: Hydennic hex water system 23.32
Residential boiler (radiator or
hydronic) i 23.32
1 Unit heaters (fuel - type, not electric),
in -wall, in -duct, suspended, etc. ! 46.75
Flue/vent for any of above 1 23.32
Subdivision: i Lot no.: ' Other. 's 23.32
Otter fuel appliances:
Tax reap /parcel no.: Water heater 1 ! 23.32
DESCRIPTION OF WORK Gas fireplace/insert T I 3339
Flue vent for water heater or gas
r i.4 Y/I a - k }?let- {_ F ✓ G fireplace l 23.32
f Log Iirdner (gas) 1 23.32
-
- Wood/pellet stove i 33.39
Wood fireplaceTnsen 23.32
I Chunaey/linerlflue/vest 23.32
PROPERTY OWNER 1 TENANT - Other 23.32 .
p EnvQOamerttal exhaust and aesti lion
Natne: 5 e744� 1 e rh ( Range boodrolher kiuebea
equpmatt 33.39
tA c
Address: /02 0 5 _ 5 L �' r l 1 d 4 y Ja "J Clothes dryer exhaust 33.39
'
City/State'ZIP: ',,I ' at U t l �� z 2 C( Single -duct exhaust (bathrooms,
3 toilet compartments, utility mortis) 23.32
Phone: 0 b Cf 74, Fa 0 Attic/crawlspace fans 23.32
APPLICANT - CONTACT PERSON Other 23.32
/A , f Feel piping:
Business name: j'41 / 45 `��,� 6e �,
�� - ,I
514.15 for fast four; $4.03 for each adtiititsral
Contact name: j//p f r /iY1 I e 1111 1-4-A A Furnace, etc.
Fe Gas heat pump
Address: (I 5� • d e p n s L c?.,z_ WaWsuspended/Imit Mato
City /State/ZIP: ./ G »fl -I s ! e; a 7[9 ./5- q Water heater
Phone: () 503 d S f, ./ 0 Fax: : ()P 7r 550 2-2 12_ Fireplace
L n / Ranee
E-mail: C/,qc, �-- 4 19 f / }- if (Al & A / ( / , e.-. e.-. Barbecue
CONTRACTOR Q •
�[ Clothes dryer (gas)
Business name:
G49 .//9/n/3S A: . ► + 1i �, � other MECHANICAL PEiIMFTFEES*
Address: / 7/ S � 1 Per j ') Ze_e G Subtotal
-i 1 . '-
Cha � /� g Q� Plan review (ZS Minimum permit fee (590.00) ' 1 }' (/rte./
CityrState/ZIP ti of permit fee)
Phone: 0 co) 6 f'� 3' Fax: 0/ r 7' So 2 9/ State surcharge (12% of permit fee) /Q WO
CCB tic.: G S ts 3 Q TOTAL PERMIT FEE f �. $U
This penal' applieai nor atpites if a permit is not obstiaed wails 180
days after it has bast accepted as rniWlete.
Authorized signature: ! /i�� r -(--------- Fee meihodology set by Tri County Building InhiOry Sesvice Board
Print name: �� #� i/f A4 I Date: 0 '3 �(/
f Olt
Mai Wiag1Perm.tsMYEC-Puenitt ppdoc 03,;742 440-44171 (i I/D2/COM/WEal